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Case number:	011
Age:	42
Clinical presentation:	Premenopausal woman with average risk of developing breast cancer presented with left mastalgia. Examination revealed no abnormality.

Mammography:

Breast composition:	ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:
‣ Location of the lesion:	Bilateral breasts, no abnormality seen
‣ Mass:
• Number:	0
• Size:	No
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	None
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

Ultrasound:

Ultrasound features: Both breasts, no abnormality seen
‣ Mass
• Location:	Both breasts, no abnormality seen
• Number:	0
• Size:	None
• Shape:	None
• Orientation:	None
• Margins:	None
• Echo pattern:	None
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	None

BI-RADS:

BI-RADS Category: 1 (negative)

Case summary:

Premenopausal woman presented with left mastalgia. Diagnosed as BI-RADS 1 on imaging.

Learning points:

Breast density of ACR category c in younger premenopausal women may limit the sensitivity of the diagnostic mammogram because small mass lesions may be hidden within the dense breast parenchyma. A supplementary breast ultrasound is performed in these women to look for small masses.